Risk Adjustment · for risk-adjustment finance and analytics

S7 RAF

The patient's risk score, itemised, updated as the codes change.

The Risk Score Agent calculates the CMS-HCC score as the coder works and shows every component — demographic base, each HCC, disease count, interactions — for the payment year the date of service implies. A what-if calculator answers 'what happens if we capture this?' before anyone decides.

Itemisedevery component visible
Liveupdates as codes change
What-ifbefore you decide

Part of the S7 platform — every product runs in the same application and works from the same clinical reference, inside your organisation's own boundary.

What S7 RAF does
  • Current CMS-HCC model, every component shown
  • Hierarchies applied correctly so nothing double-counts
  • Payment year chosen from the date of service
  • What-if calculator for hypothetical code sets
  • Never an estimate: if it cannot calculate, it says so
The agents inside S7 RAF

1 agent. What each reads, produces, and never does.

Risk Score Agent
Autonomous · CMS-HCC

Calculates the patient's risk score under the current CMS model as the codes change, and shows every component — demographic base, each HCC, disease count and interactions — so nothing is a black box. It uses the payment year the date of service implies.

Readsthe patient's demographics and verified diagnoses
Producesthe risk score and its full breakdown
Nevershows an estimate when it cannot calculate
autonomousfully itemised
How it runs

Step by step.

Identify the patient's segment

From age and coverage, with the assumption shown and changeable.

Apply the hierarchies

Only the categories that actually count are scored.

Itemise the score

Base, each HCC, disease count and interactions, each visible.

Try alternatives

The what-if calculator runs the same calculation on a hypothetical set.

Guardrails

What S7 RAF is built never to do.

estimate

If it cannot calculate, it shows nothing rather than a guess.

double-count

Hierarchies are applied before scoring.

guess the year

The payment year follows the date of service.